The IAC investigates complaints that identify specific noncompliance to the IAC Division Standards and/or the IAC Accreditation Program Policies and Procedures. Information Of Person Filing ComplaintPrefixDr.Mr.Mrs.Ms.Name First Last Title Address Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneEmail DO YOU WISH TO REMAIN ANONYMOUS?:(Required) Yes No RELATION TO COMPLAINT (select one only):(Required) Employee Former Employee Employee of Another Facility Patient Relative of Patient Consumer Information Regarding ComplaintTHIS IS A (select one only):(Required) Accredited Facility Non-Accredited Facility Other Facility Name(Required) Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code PhoneWebsite Address Please enter the full URL (e.g., https://intersocietal.org).NATURE OF COMPLAINT (select one only):(Required) Accredited Facility Non-Compliance to IAC Division Standards and/or Accreditation Policies and Procedures Misrepresentation of Accredited Status Misrepresentation of IAC Endorsement Other Fraud Provide specific details regarding the alleged complaint including name any persons involved, dates, times:(Required)Attach any supporting documentation in the box below. Remove any patient-related personal information from documents unless the complaint is being submitted by or on behalf of the patient.Max. file size: 32 MB.HAVE YOU CONTACTED ANY OF THE FOLLOWING IN RELATION TO THIS COMPLAINT? (select one only):(Required) Any Other Accrediting Agency (if yes, specify) Any Employees or Representatives of the Facility (if yes, specify) Any Local, State or Federal Agencies (if yes, specify) Other (if yes, specify) No, I have not contacted anyone regarding this complaint I have contacted:(Required) Date Complaint Submitted(Required) MM slash DD slash YYYY Consent(Required) By checking this box, I declare, under penalty of perjury, that the information in this complaint is true and complete to the best of my knowledge.NameThis field is for validation purposes and should be left unchanged.